RN Nurse Medical Mgmt I/II (Remote - Medicare Central Division) - IN, KY, MO, MI, OH, TN, GA

RN Nurse Medical Mgmt I/II (Remote - Medicare Central Division) - IN, KY, MO, MI, OH, TN, GA

20 Sep 2024
Ohio, Columbus 00000 Columbus USA

RN Nurse Medical Mgmt I/II (Remote - Medicare Central Division) - IN, KY, MO, MI, OH, TN, GA

Vacancy expired!

RN Nurse Medical Mgmt I/II (Remote - Medicare Central Division) - IN, KY, MO, MI, OH, TN, GALocation: Indiana, United StatesNewRequisition #: PS26643Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.This Nurse Medical Mgmt. I/II position supports the Medicare Central States. You will be given the training and equipment to work from a home office. You must have a high speed internet connection. You must live in one of the central states to be considered: IN, KY, MO, MI, OH, TN, GAThe Nurse Medical Mgmt. I/II is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medicallyappropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.Primary duties may include, but are not limited to:Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planning.Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.Requires a current, active, unrestricted RN license in the state in which you live and 2 years of clinical experience.-Managed care experience preferred.-Utilization Management experience preferred.-Computer Skills: MS Office (Word, Outlook, Excel) This position requires you to work with web-based applications utilizing multiple screens to research, input and update information. You must be comfortable working on a computer.-Requires strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills.-Must be self-motivated to work from home, with a strong work ethic and professional approach to all tasks.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.An Equal Opportunity Employer/Disability/Veteran

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Job Details

  • ID
    JC2720122
  • State
  • City
  • Full-time
  • Salary
    N/A
  • Hiring Company
    Anthem
  • Date
    2019-09-21
  • Deadline
    2019-11-19
  • Category

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